深静脉穿刺包行经皮气管切开术在神经重症患者中的应用效果

Effect of percutaneous tracheotomy with deep vein puncture bag in the treatment of severe neurological patients

目的探讨深静脉穿刺包行经皮气管切开术在神经重症患者中的应用效果。方法选取阜阳市第五人民医院神经外科自2016年12月至2019年10月收治的45例行经皮气管切开的神经重症患者为研究对象,按照使用材料不同分为试验组(23例)与对照组(22例)。试验组使用深静脉穿刺包行经皮气管切开术,对照组使用常规气管切开包行经皮气管切开术。比较2组患者的手术情况、手术费用及术中、术后相关并发症的发生率。结果2组患者一般情况(性别、年龄、病因及术前GCS评分)比较差异无统计学意义(P>0.05);试验组手术相关费用[(694±22)元]明显低于对照组[(1402±184)元],差异有统计学意义(t=18.223,P=0.000);手术情况比较:手术时间、切口大小、术中出血量、导丝弯折率及更改术式发生率比较差异无统计学意义(P>0.05);2组患者术中、术后并发症(术后渗血、低氧血症、心律失常、皮下气肿、气胸、纵膈气肿、切口感染、切口处溢痰及套管脱出)发生率比较差异无统计学意义(P>0.05)。结论在熟练掌握常规经皮气管切开术的前提下,神经重症患者应用深静脉穿刺包行经皮气管切开术同样具有创伤小、手术时间短、并发症少等特点,降低手术成本,值得临床推广应用。

Objective To investigate the effect of percutaneous tracheotomy with deep vein puncture package in severe neurological patients.Methods Forty-five patients with severe neurological diseases admitted to neurosurgery department of Fuyang Fifth People’s Hospital from December 2016 to October 2019 who underwent percutaneous tracheotomy were selected as the study subjects.According to different methods of using materials,the patients were divided into experimental group(23 cases)and control group(22 cases).The experimental group received percutaneous tracheotomy with deep vein puncture package,while the control group received percutaneous tracheotomy with conventional tracheotomy package.Surgical conditions,surgical costs and the incidence of intraoperative and postoperative complications were compared between the two groups.Results There was no significant difference between the two groups in general conditions(gender,age,etiology and preoperative GCS score)(P>0.05).The surgical expenses in the experimental group[(694±22)yuan]were significantly lower than those in the control group[(1402±184)yuan],and the difference was statistically significant(t=18.223,P=0.000).Comparison of surgical conditions:there were no statistically significant differences in operative time,incision size,intraoperative blood loss,guide wire bending rate and the incidence of surgical changes(P>0.05).There was no statistically significant difference between the two groups in intraoperative and postoperative complications(postoperative bleeding,hypoxemia,arrhythmia subcutaneous emphysema,pneumothorax,mediastinum emphysema,incision infection,sputum discharge at the incision and cannula prolapse)(P>0.05).Conclusion Compared with conventional percutaneous tracheotomy,percutaneous tracheotomy with deep veni puncture bag also has the characteristics of less trauma,shorter operation time and fewer complications,which can reduce the cost of operation and is worthy of clinical application.